title: Changing ethnic disparity in ischemic stroke mortality in US children after the STOP trial.
abstract: OBJECTIVE
  A prior report showed higher stroke mortality in US black children compared with white children (1979-1998), a disparity likely due in part to sickle cell disease, which leads to a high risk of childhood ischemic stroke. We hypothesized that this disparity has diminished since the publication of the Stroke Prevention Trial in Sickle Cell Anemia (STOP trial) in 1998 demonstrating the efficacy of long-term blood transfusions for primary stroke prevention.
  
  
  OBJECTIVE
  To evaluate the demographics and secular trends in mortality from ischemic and hemorrhagic stroke (as a primary cause of death) in US children (<20 years) and determine if there has been a decrease in the disparity between white and black children since the publication of the STOP trial in 1998.
  
  
  METHODS
  We used death certificate data from the National Center for Health Statistics, 1988 through 2007.
  
  
  METHODS
  United States.
  
  
  METHODS
  Children who died in 1988 through 2007 in the United States.
  
  
  METHODS
  Publication of the STOP trial.
  
  
  METHODS
  Incidence rate ratios were calculated as the measure of relative risk.
  
  
  RESULTS
  Among 1.6 billion person-years of US children (1988-2007), there were 4425 deaths attributed to stroke, yielding an average of 221 deaths per year; 20% were ischemic; 67%, hemorrhagic; and 12%, unspecified. The relative risk of ischemic stroke mortality for black vs white children dropped from 1.74 from 1988 through 1997 to 1.27 from 1998 through 2007. The ethnic disparity in hemorrhagic stroke mortality, however, remained relatively stable between these 2 periods: black vs white relative risk, 1.90 (1988-1997) and 1.97 (1998-2007).
  
  
  CONCLUSIONS
  The excess risk of death from ischemic, but not hemorrhagic, stroke in US black children has decreased over the past decade. This may be related to the implementation of an effective ischemic stroke prevention strategy for children with sickle cell disease.
authors.affiliation: Department of Neurology, Boston Children's Hospital, Boston, MA, USA. laura.lehman@childrens.harvard.edu
authors.forename: Laura L
authors.initials: LL
authors.lastname: Lehman
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Fullerton
mesh_terms: D001741:Black or African American; D002545:Brain Ischemia / Q000150:complications / Q000401:mortality*; D002648:Child; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D020521:Stroke / Q000209:etiology / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D044465:White People